Friday, January 30, 2009

Health Experts Versus Doctors

I love reading the peer-reviewed medical literature. While others may see it as a chore or as a requirement of the job, I love learning new things and even more love the humor of it. Yes - humor. The opinion pieces that have all the answers and the "new" data that just repeats knowledge that has been known for years yet does so in a breathless fashion that makes it sound as though no one in the world had ever known it before. I love the challenge of translating the articles into English and cutting through the jargon that often obscures any real practical meaning. My own game of trying to discern the bias in the authors even when they present themselves as totally objective only adds to the fun. As I build this blog, I will be turning to the medical literature as my muse. I will read it to be inspired as much as be informed and then will share my thoughts, feelings and any other random insights that I may glean from them.

Today I am struck by two opinion pieces that were published one week apart in one of the best, most prestigious journals currently being published. That is the New England Journal of Medicine. In the January 22nd issue there is an article by Michael Sparer, a health policy professor at Columbia University and a lawyer and PhD by background in which he advocates for an expansion of Medicaid as one key part of a solution to the health care crisis. One week later, in the January 29th issue of that same journal, Jonathan Gruber, a professor of economics at MIT writes about the need to expand our public programs (i.e. Medicaid and Medicare) to improve our economy.

I see those two articles as the one two punch by two people who may be seeing clearly on one level, but I would surmise see things from a very different prospective than would a physician in practice who has to often fight for government reimbursement, which is often signficantly less than from the private market. Public payment is based on the RBRVS system which stands for the Resource Based Relative Value System. Most physicians believe that it really stands for Really Bad Reimbursement Very Slowly. While most doctors do want to see universal coverage, most would not want it based on an expansion of Medicaid and Medicare. Does the back to back publication of these two articles reveal an editorial bias? I do not know and I respect grately the thoughts and credentials of the authors. However I respect them as academic thought leaders and when I am sick, I want a doctor who is happy in what he or she does and feels fairly compsated to care for me, not an academic thought leader. Whatever solutions we develop will need to understand the realities of practice for physicians and address the need to keep them challenged, productive and satisfied with their careers.